Barriers and facilitators to using self-sampled tests for the human papillomavirus (HPV): a mixed-methods study to inform a horizon scan.

Abstract

Objectives: Human papillomavirus (HPV), particularly high-risk types such as HPV 16 and 18, is a major cause of cervical cancer and other cancers. Despite the United Kingdom's (UK's) commitment to cervical cancer elimination by 2040, participation in HPV screening is declining, disproportionately affecting underserved groups, including those experiencing poverty, people from minoritized racial, ethnic, gender, or sexual identity groups, and people living with HIV.

Methods: We conducted a mixed-methods study to explore awareness, barriers, and facilitators to HPV self-sampling from clinician and public perspectives. A multi-stakeholder survey (n = 105) and two online focus groups with clinicians (n = 4) and members of the public (n = 5) were undertaken.

Results: Survey respondents identified accuracy, cost-free availability, ease of use, accessibility, clear instructions, and adequate follow-up as critical test features. Participants emphasized that disability, cultural context, language, and socioeconomic status strongly influence barriers and facilitators to uptake. Focus groups provided contextual depth, illustrating how privacy, logistical and emotional impacts, and supportive follow-up pathways shaped acceptability and trust. Clinicians highlighted the need for integration into healthcare infrastructure to maintain trust and ensure support. Public participants recommended community-driven engagement, including multilingual instructions and tailored communication to encourage adoption among diverse groups. Concerns were raised about unintended consequences, such as anxiety following asymptomatic HPV diagnoses and challenges in managing clinical pathways after positive results. Suggestions included leveraging community organizations to reduce hesitancy.

Conclusions: Findings highlight policy and implementation considerations for embedding HPV self-sampling within care pathways to improve uptake and reduce inequalities.